On June 9, 2005, the Supreme Court of Canada issued a decision in the matter of Chaoulli v. Quebec (Attorney General). The majority of the court found that prohibiting privately-funded health care leads to waiting lists. They concluded that those waiting lists can and have led to deaths and to physical and psychological harm and pain. They concluded that prohibiting privately-funded health care creates patient pain without any corresponding public healthcare gain. And, for those reasons, the majority declared Quebec’s prohibition of privately-funded health care is an unjustifiable violation of an individual’s rights to life and security of the person.

The court’s decision does not render private health care prohibitions in Canada’s other provinces unconstitutional, but the reasons for the decision certainly make it clear that prohibitions in other provinces may in the future be found unconstitutional iftheir respective government health care monopolies leave patients as poorly attended as they are in Quebec’s government-run health care system: according to the reasons for the decision, Quebec’s prohibitions never would have been declared unconstitutional if Quebec’s government-run health care system had provided “reasonable” levels of health care. Throughout Canada now, the left is staring at that “if” without a blink, and they are engaged in an all-out war of words to make sure that Canadians believe that the court’s decision imposes a duty to dump even more tax dollars into government health care. In newspapers, on television, in the board rooms of numerous left-wing health care NGOs, “how can we improve the government system and thereby keep the prohibitions in place in Canada’s other provinces?” is, foolishly, the focus of almost all related discussion.

One would like to think that at least the National Post- arguably the Canadian newspaper most sympathetic to free market economic reforms – could be relied upon to make the case for privately-funded health care. Such has not been the case. Instead, the National Post has published a number of columns and editorials issuing warnings of possible pitfalls of capitalist competition in health care funding, and promoting what is nowadays politely labelled “corporativism”, “public-private partnership” or “the third way”, but what was originally known as “fascism“: a system in which private companies serve a single payor – the government – which sets down rules and regulations dealing with such things as the nature, quantity and speed of services provided, the prioritization of service recipients, and the prices at which services will be provided.

For example, on June 10, 2005, columnist Andrew Coyne re-assured Canadian socialists and corporativists that:

“Despite what you may have heard, yesterday’s Supreme Court decision does not mean the “end of medicare.” It does not even necessarily mean the legalization of private insurance, at least outside of Quebec. …Conservatives who are already citing the court’s ruling in support of a parallel private health care system…are as unconvincing as the Prime Minister’s smug assurances that all is well because of last September’s health care accord….The case for private insurance would be more compelling were there reason to believe the public system was operating at maximum efficiency…Nor are we lacking for detailed plans for reform. These are to be found…in two other recent inquiries: the report of the Senate committee headed by Senator Michael Kirby, and that of the Alberta government commission headed by Don Mazankowski. Both propose radical reforms to the delivery and funding of health care — but within the envelope of public finance. That is, each would seek to import the basic mechanisms that make private markets such efficient allocators of resources – choice, competition, prices — while preserving the “single payer” model.”

On June 11th, Mr. Coyne continued his pitch:

“But the right of an individual patient to purchase private insurance, in the particular circumstances of his own situation, need not be the model for society as a whole. There may bebetter ways of alleviating waiting times in the public system than by allowing a private system to work alongside it, which would obviate the need for such drastic remedies. And indeed the evidence suggests there is: a system of “internal markets,” along the lines proposed by the Kirby committee or Alberta’s Mazankowski commission.”

On June 17, 2005, the National Post published a colum by Adam Radwanski, who wrote:

Preserving the same system for Canadians of every social, economic and regional background is a noble and worthy goal; indeed, it’s essential to preserving the sense of social responsibility on which this country has been built. But that aim has been clouded by politicians and interest groups who, to either score points against their rivals or maintain a status quo they benefit from, have lumped together universal care with the manner in which it is delivered…Universality is a question of principle; delivery is one of practicality…Last week’s ruling represents an opportunity as much as a threat — a chance for a long overdue dialogue that puts all the delivery options on the table in order to ensure universality for the long-haul.”

Most recently (on June 29, 2005), the National Post ran an editorial that stated:

With the Liberals having bizarrely dismissed the [Chaoulli] decision out of hand, and with Health Minister Ujjal Dosanjh now picking fights with the Canadian Medical Association because doctors dared suggest a role for the private sector in medicare, a Conservative campaign in favour of greater flexibility within the public system could not be more timely.

Given the sort of columns that the National Post has been publishing, that assertion clearly implies private sector delivery of health care services within a system in which government is the only payor. The assertion could not be more counter-productive and harmful to the future of Canadian healthcare. And given that it is coming from a paper that – rightly or wrongly – is widely thought to be pro-capitalist, there is a definite risk that the National Post’s pro-corporativist/anti-capitalist proposal will be mislabeled “capitalist”, thereby undermining the very concept, and defaming capitalism in general. Yet capitalist health reforms, not corporativist partnerships between government payors and private sector service deliverers, are a Canadian patient’s only hope.

He who pays the piper calls the tune. In a system funded only by government, politicians are the only payors. As such, they demand of health care service providers one thing: a system that, by appearing good enough, keeps voter discontent sufficiently low to avoid ejection from office. Vendors – even private sector vendors – respond the only way they can: by rationing healthcare. As a result, patients suffer and die on waiting lists. In truth, this is of little relevance to the politician, because only aminority of voters are in health care waiting lists, and because those who die in line do not vote. It is also of little concern even to a private-sector vendor: having kept the politicians happy, it gets a comfortable, competition-free, seat at the government trough.

Patients do not want better rationing. They do not care if “average wait times” are reduced. They want their own wait times reduced, and they know that decreased averages might have no effect at all on the amount of time they wait. Canadian patients also know that waiting is not the only problem: the quality of service delivered patients takes precedence, as it should, over any socialist, ideologically-driven commitments to “save universal health care”.

Introducing more “private delivery” of publicly-funded health care will not end rationing, it will not improve wait times significantly (if at all), and it most certainly will not improve patient satisfaction. The time is now to allow each Canadian to make their funding of the public system optional. We must allow patients also to be the payors, so that they can call the tune, instead of the government doing so. Their tune, I assure you, will be not “save the system” but “save the patient“. Health care providers then will either play that tune, or go out of business. And that is exactly as it should be.

That the public cares more about results than about the means used to achieve them is most certainly true. However, I must disagree with your conclusion that “everyone would be better off if politicians promised results instead of mechanics.”

On some level, everyone wants the same things — better services at a lower cost. With all politicians promising those results and avoiding debate on how to achieve them, distinguishing politicians at election time could amount to little more than debates about managerial competence and name recognition.

In response, all parties would be encouraged to choose leaders who were former CEOs or movie stars, no matter how lacking in political vision or courage. But government is not business and it certainly ought not to be show business. To make informed choices in the voting booth, we must each be able to gauge the feasibility of parties’ promised goals by independently evaluating the means by which they propose to achieve them.

Whereas all politicians clearly must “steer clear of empty and counterproductive promises starved of ideas,” it would be an error, and a disservice to the voter, to steer clear of ideas altogether. Let’s not throw the baby out with the bathwater.